CORNS, CALLUSES AND PAIN MAY INDICATE JOINT PROBLEMS
Many disorders can affect the joints of the toes, causing pain and preventing the foot from functioning as it should. People of all ages can have toe problems, from infants born with deformities, to older adults with acquired deformities.
The major culprit of toe deformities in adults is tendon imbalance. When the natural function of the foot is disrupted (through a variety of causes), the tendons may stretch or tighten to compensate. Thus, people with abnormally long toes, flatfeet or high arches have a greater tendency to develop toe deformities.
Arthritis that slowly destroys the joint surface is another major cause of discomfort and deformity. Toe deformities also can be aggravated by restrictive or ill-fitting footwear worn for a prolonged amount of time. Or, problems with toe position may occur if a fractured toe heals in a poor position.
The most common digital deformities are hammertoes, claw toes, mallet toes, bone spurs, overlapping and underlapping toes, and curled toes.
These deformities may or may not be painful. Corns and calluses - a buildup of skin on the affected joint, often associated with bursitis (inflammation of small pouches, called bursas, which lie above the joint between the tendon and skin) - are perhaps the most noticeable and bothersome symptoms. If deformities are left untreated, the toe's mobility may become limited, and more serious problems, such as skin ulceration and infection, may develop.
A hammertoe may be flexible or rigid, and may occur on any of the lesser toes. Ligaments and tendons that have tightened cause the toe's joints to buckle, cocking the toe upward. Shoes then rub on the prominent portion of the toe, leading to inflammation or bursitis. Corns and calluses soon form.
During the early stages, a hammertoe remains flexible, meaning it will straighten when pressure is applied to the buckled area. As time passes, the toe can become permanently buckled or rigid, requiring surgery for correction. Painful calluses on the bottom of the foot may accompany rigid hammertoes because of pressure generated on the joint.
A bone spur is an overgrowth of bone that may occur alone or along with a hammertoe. Pain, corns and calluses are the major symptoms. Left untreated, a bone spur may eventually be accompanied by bursitis or small skin ulceration.
Overlapping and Underlapping Toes
Any one of the toes can overlap or underlap, pushing on adjacent toes and causing irritation.
Overlapping or underlapping of the fifth toe is a common congenital problem that is easily corrected in children. Bunions can cause the second toe to overlap in adults.
Pain, inflammation and small corns on areas of built up tissue may result. This deformity also can interfere with the normal function of the foot, and if left untreated, may lead to enlargement of bone or bone spur formation.
TREATMENTS FOR TOE DEFORMITIES
Any toe problems that cause pain or discomfort while walking should be given prompt attention by a podiatric surgeon. Ignoring the symptoms can aggravate the condition, and over time may lead to an infection, a breakdown of tissue or ulceration. For people with poor circulation or an underlying medical problem, loss of the toe is possible.
Recommended treatments will vary depending upon the severity of the condition.
For people who have minor discomfort, less advanced conditions or are unable to undergo surgery, the symptoms may be treated conservatively (without surgery). This usually involves:
- Trimming or padding corns and calluses.
- Wearing supportive orthotics (individually fitted plastic or leather inserts) in shoes. This helps relieve pressure on toe deformities and allows the toes and major joints of the foot to function more appropriately.
- Splints or small straps to realign the toe.
- Wearing shows with a wider toe box.
In certain cases, anti-inflammatory medications may be injected to relieve pain and inflammation. Medications have proven to be successful in relieving the discomfort associated with bursitis. Unfortunately, conservative treatments provide only temporary relief of symptoms - they do not correct the deformity.
When the deformity is painful and permanent, surgical correction is recommended to relieve pain, correct the problem and provide a stable, functional toe. Some of the most common surgical procedures are described below.
Depending on health status, surgery may be conducted on an outpatient basis at the surgeon's office. The procedures are usually comfortably performed under local anesthesia or with intravenous sedatives administered by trained anesthesia personnel.
CARE AFTER SURGERY
Some swelling, stiffness and limited mobility can be expected following surgery, sometimes for as long as eight to twelve weeks.
Keeping the foot elevated above heart level and applying ice packs will help reduce swelling during the first few days after surgery. Many people can walk immediately afterward, although the podiatric surgeon may restrict any such activity for at least 24 hours.
Wearing a splint or surgical shoe for the first two or three weeks after surgery is recommended. The shoe protects the foot and helps properly disperse body weight. Stitches, if present, must be kept dry until removal - generally seven to ten days following surgery.
While these are some of the most commonly prescribed treatments for digital disorders, others may be used. The podiatric surgeon will determine which treatment is likely to be the most successful in each case.
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